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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601451
Report Date: 11/05/2025
Date Signed: 11/05/2025 01:21:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250707144910
FACILITY NAME:KARO MINA CARE HOMEFACILITY NUMBER:
075601451
ADMINISTRATOR:EWEDA, MONAFACILITY TYPE:
740
ADDRESS:2866 LARAMIE AVENUETELEPHONE:
(925) 551-8263
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 2DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator, Mona EwedaTIME COMPLETED:
01:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained pressure injuries due to staff neglect
Staff did not provide resident with a 60day notice of rent increase
Staff are not meeting residents hygiene needs
Staff are not meeting residents dietary needs
Staff not following residents care plan
Staff are not adequately trained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/05/2025 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegations. LPA met with Caregiver, Ulanda Mitchell and explained the purpose of the visit. Administrator notified and arrived at 10:00AM

During course of the investigation, LPA conducted interviews with facility staff, witnesses and residents. Documents including but not limited to: admission agreements, physician’s reports, care plans, photos of residents, care notes, and text messages were obtained and/or reviewed.

Report continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
VISIT DATE: 11/05/2025
NARRATIVE
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Pg. 2 continued
On the allegation "Staff not following residents care plan" the following was found: On 7/16/2025 LPAs A Gomez and T Syess-Gibson conducted the initial investigation visit. During the visit LPAs met with staff 1 (S1), Licensee, resident 3 (R3), and resident 4 (R4). LPAs reviewed available records for R1, R2, R3, and R4. LPAs observed in R3's records that they required assistance rotating every 2 hours. LPAs were at the facility continuously from 1:00PM- 4:15PM and observed that R3 was not rotated until LPAs requested that staff rotate them. On 8/20/2025 LPAs A Gomez and Y Brown returned to the facility to continue the investigation. LPAs observed that the Facility was crushing medications for R3 and R4 without a crush order on file. On 11/4/2025 LPA A Gomez interviewed R1, R2, and witness 1 (W1) . During the interviews with W1 it was disclosed that R1 sustained pressure injuries due to facility staff not encouraging and assisting R1 as discussed as part of their care plan. It was also disclosed that R1 was having flare-ups with their skin due to inconsistent use of their ointment. LPA cross verified this information with text messages from R1's Home Health Nurse. Therefore the allegation "Staff not following residents care plan" is Substantiated.

On the allegation "Resident sustained pressure injuries due to staff neglect" the following was found: On 11/4/2025 LPA A Gomez interviewed W1 and reviewed photos, and text messages from R1's Home health Nurse. R1 was admitted to the facility on 2/1/2025. LPA observed that on 2/7/2025 R1 did not have any pressure injuries on their bottom. On 2/11/2025 LPA observed that a pressure injury had began to form on R1's bottom but was not yet open. According to the Home Health Nurse the pressure injury was developing because of sitting for prolonged periods of time. Nurse advised for R1 to stand and walk every hour to prevent the wound from developing further. Between 2/12/2025 and 2/19/2025 it was documented that the pressure injury on the bottom had opened and developed further. Wound healed by 5/20/2025. Therefore the allegation "Resident sustained pressure injuries due to staff neglect" is Substantiated.

Report continues on LIC9099-C
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
VISIT DATE: 11/05/2025
NARRATIVE
1
2
3
4
5
6
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8
9
10
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Pg. 3 Continued

On the allegation "Staff did not provide resident with a 60day notice of rent increase" the following was found: On 10/22/2025 LPAs A Gomez and A Gharachorloo conducted a visit to continue the investigation. During the Visit LPA's interviewed the Licensee/Administrator. During the interview when asked if they gave a 60 day notice of rent increase Administrator stated that, "they did increase the rent for R1 two (2) times because they needed a higher level of care; each time the rent was raised they state that they gave a 30 day verbal notice and that they were not aware that they needed to give a 60 day notice." On 11/4/2025 LPA observed text messages from Administrator stating that the rent would be increased the upcoming month due to R1's incontinence care, cost of living, and expenses and that if they did not agree they could submit a 30 day notice and leave the facility. R1 was admitted to the facility on incontinence care and there was not a change in condition. Therefore the allegation "Staff did not provide resident with a 60day notice of rent increase" is Substantiated.

On the allegation "Staff are not meeting residents hygiene needs" the following was found: On 11/4/2025 LPA A Gomez conducted separate interviews with R1, and R2. Both R1 and R2 disclosed to LPA that the facility would monitor them while they were in the restroom and that they had to ask for toilet paper. R1 and R2 states that toilet paper was not readily available in the bathroom and that they would have to throw their used toilet paper away in the trash can. On 11/4/2025 LPA also observed messages from the Home Health Nurse stating that in April of 2025 they had found R1 with feces on their private parts and that they had to inform staff to clean R1. Therefore the allegation "Staff are not meeting residents hygiene needs" is Substantiated.



Report Continues on LIC9099-C
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
VISIT DATE: 11/05/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
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Pg. 4

On the allegation "Staff are not meeting residents dietary needs" the following was found: On 7/16/2025 LPAs observed during the initial complaint visit that R4 was thirsty and had not had any food or water since they had arrived at 1:00PM. LPAs had to request for staff to give R4 something to drink. On 8/20/2025 during a return visit LPAs observed that the food being prepared for residents lunch was expired. LPAs also observed expired canned goods, and food items in the refrigerator. On 10/22/2025 during a return visit LPA's inspected the refrigerator and observed additional expired foods in the refrigerator. On 11/4/2025 LPA interviewed W1. W1 provided text messages and photos of R1 being swollen because their no salt diet was nit being followed. W1 also disclosed that they witnessed staff attempting to prepare tater tots for R1 which goes against their dietary needs. Therefore the allegation "Staff are not meeting residents dietary needs" is Substantiated.

On the allegation "Staff are not adequately trained" the following was found. On 7/10/2025 LPAs requested training records for all staff on the LIC 500. LPAs observed that all staff with the exception of the Administrator were not up to date on their training. Interviews with S1 concluded that they did not have the required knowledge to effectively conduct their role as a caregiver. Therefore the allegation "Staff are not adequately trained" is Substantiated.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250707144910

FACILITY NAME:KARO MINA CARE HOMEFACILITY NUMBER:
075601451
ADMINISTRATOR:EWEDA, MONAFACILITY TYPE:
740
ADDRESS:2866 LARAMIE AVENUETELEPHONE:
(925) 551-8263
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 2DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator, Mona EwedaTIME COMPLETED:
01:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff engaged in a verbal altercation in the presence of residents
Staff inappropriately using dirty washcloths
Staff did not ensure resident received a copy of admissions agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/05/2025 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegations. LPA met with Caregiver, Ulanda Mitchell and explained the purpose of the visit. Administrator notified and arrived at 10:00AM

During course of the investigation, LPA conducted interviews with facility staff, witnesses and residents. Documents including but not limited to: admission agreements, physician’s reports, care plans, photos of residents, care notes, and text messages were obtained and/or reviewed.

Report continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
VISIT DATE: 11/05/2025
NARRATIVE
1
2
3
4
5
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7
8
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Pg. 2

On the allegation "Staff engaged in a verbal altercation in the presence of residents" the following was found: On 11/4/2025 LPA interviewed R2 who states that they would sometimes hear the Licensee raise their voice at caregivers. R1 was also interviewed but could not recall any altercations at the facility. During all visits LPAs observed that the Administrator can become elevated during discussions however it is attributed to their cultural expression rather than aggression. Therefore the allegation "Staff engaged in a verbal altercation in the presence of residents" is Unsubstantiated.

On the allegation "Staff inappropriately using dirty washcloths" the following was found: LPAs did not observe any dirty washcloths during visits and no residents reported a concern of dirty washcloths being used on them. Therefore the allegation "Staff engaged in a verbal altercation in the presence of residents" is Unsubstantiated.

On the allegation "Staff did not ensure resident received a copy of admissions agreement" the following was found: Based on interview with Licensee and W1 LPA was unable to conclude if the resident ever received a copy of the admissions agreement. Licensee states that they gave a physical copy of the agreement. Therefore the allegation "Staff did not ensure resident received a copy of admissions agreement" is Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2025
Section Cited
CCR
87468.2(a)(8)
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7
(a)In addition to the rights listed in Section 87468. … the elderly shall have all of the following personal rights: (8)To be free from neglect… or sexual abuse.

The following requirement was not met as evidence by:
1
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7
By POC Licensee agrees to review the regulation, develop a poster on how to prevent pressure injuries, have poster posted for staff, provide a copy of poster to CCLD via certified mail and notify CCLD.
8
9
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14
Based on interviews with W1 and review of text messages R1 sustained pressure injuries due to staff neglecting to ensure proper movement which poses an immediate health and personal rights violation to resident in care.
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Type A
11/19/2025
Section Cited
CCR
87555(a)
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(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.

The following requirement was not met as evidence by:
1
2
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By POC Licensee agrees to review the regulation, develop a poster on how to inspect for expired food, when to discard, food life, and identifying and how to adhere to special diets, have poster posted for staff, provide a copy of poster to CCLD via certified mail and notify CCLD.
8
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Based on interviews with W1, photos, text messages with home health, and observations made at the facility by LPAs the facility is not providing quality food due to having expired foods in use for residents such as potatoes, pre-cooked meals, and produce as well as not following R1’s no salt diet which led to them swelling which poses an immediate health and personal rights violation to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2025
Section Cited
HSC
1569.655(a)
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2
3
4
5
6
7
(a) If a licensee .. increases the rates… the licensee shall provide no less than 90 days’ prior written notice… including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident.

The following requirement was not met as evidence by:
1
2
3
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6
7
By POC Licensee agrees to review the regulation, register and complete a training related to rate increases/admission agreements by an approved CCLD vendor that they have not used before, and notify CCLD.
8
9
10
11
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14
Based on interviews with Licensee, W1, and review of text messages the Licensee raised the rent without proper notice twice which poses a potential personal rights violation to resident in care.
8
9
10
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14
Type B
11/19/2025
Section Cited
CCR
87307(a)(3)(D)
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7
(a)Living accommodations …shall apply: (3)Equipment and supplies necessary for personal care …the licensee shall assure provision of: (D)Hygiene items of general use such as soap and toilet paper.

The following requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC Licensee agrees to review the regulation, register and complete a training related to personal accommodations and services by an approved CCLD vendor that they have not used before, provide all required hygiene supplies with extra supply available for resident use in the bathroom, and notify CCLD.
8
9
10
11
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13
14
Based on interviews with R1, R2, and W1 the facility was not providing basic hygiene needs by not readily providing toilet paper which poses a potential personal rights violation to resident in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 15-AS-20250707144910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KARO MINA CARE HOME
FACILITY NUMBER: 075601451
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2025
Section Cited
CCR
87464(f)(4)
1
2
3
4
5
6
7
(f)Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.

The following requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC Licensee agrees to review the regulation, register and complete a training related to basic services by an approved CCLD vendor that they have not used before, update all needs and services plans for existing residents, provide copies of the plans to CCLD via certified mail, and notify CCLD.
8
9
10
11
12
13
14
Based on interviews with W1, record review, observations made during visits the facility was not following the careplans’ for R3 by not assisting them with repositioning every 2 hours, and not following R1’s careplan which poses a potential personal rights violation to resident in care.
8
9
10
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14
Type B
11/19/2025
Section Cited
CCR
87411(a)
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2
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6
7
(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…facility require such additional staff for the provision of adequate services.

The following requirement was not met as evidence by:
1
2
3
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5
6
7
By POC Licensee agrees to provide copies of all current trainings to CCLD via certified mail, and notify CCLD.
8
9
10
11
12
13
14
Based on interviews with S1, and record review staff were not up to date on their training or competent to provide the required care and assistance which poses a potential personal rights violation to resident in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 9